摘要
通过技术改进和经验积累，在不降低直肠癌手术安全性、有效性和微创性的基础上，探讨扩大腹腔镜下直肠癌根治术的适用范围。应用4～5孔法实施于术，术中根据肿瘤位置和大小，确定肠系膜保留位置，为术后盆壁腹膜化重建做好准备，按照标准的直肠全系膜切除术要求，循解剖间隙实施手术。肠系膜血管采用解剖性游离然后结扎切断和提出腹腔外处理两种方法。充分显露腹膜返折及以下盆腔空间，腹腔镜下使用五叶拉钩，较好地解决了空间不利于显露的缺点。消化道的重建采用完全腹腔镜手术、腹腔镜辅助手术、肛门拖出吻合器吻合以及人工吻合等方法。盆底腹膜主要用连续缝合关闭（84％），部分（9％）采用腹膜整合使大部分腹膜关闭，少量（5％）采用完全不关闭。结果显示，62例中57例手术成功，1例直肠中动脉出血，4例晚期肿瘤侵犯周围脏器中转开腹。手术时间平均175min，术中出血量平均70ml，术后住院时间平均9d，无严重并发症。本组患者随访3～36个月，平均15个月，失访率5％，1年生存率91％，3年生存率76％。6例拖出式吻合患者排便次数较多，6～9个月后好转。结果表明，经过技术改进，腹腔镜下直肠癌根治术可以被更广泛地应用。
The aim of this study was to explore increasing the applicable range of laparoscopic radical procedure for rectal carcinoma based on safe, effective and microtrauma through technique improvement and experience accumulation. The 4-5 hole method was used to perform operation. In operation based on the location and size of tumor confirming the location of mesentery-preserved was taken thus for reconstruction of pelvic-wall peritoneum;according to TME standard along with anatomic space operation was done;mes- entery blood vessels were managed by both methods of using anatomic free and then ligation ＆ cut,and by using taking out abdominal cavity; completely manifesting peritoneal intussusception and inferior pelvic space,laparoscopic using five-leaf retracter could better resolve the shortcoming as space to be opened not enough;by using complete laparoscopic procedure, laparoseopic adjuvant procedure and pull through the anus anastomosis by stapler,as well man-made anastomosis,and so on,were used to reconstruct digestive tract;pelvic-floor peritoneum was closed mainly（84Y0） by using continuous suture closure,partially（90%） by using peritoneum renovation,so that most part to be closed, but minor （5%） no-closed completely. As results,among the 62 cases 57 got success,l case occurecl bleeding of rectal mid-artery,4 cases got midway open abdomen procedure due to advanced tumor invasive the surrouding organs;average operative time was for 175 min, average bleeding volume during operation was 70 ml, average postoperative hospitalization time was 9 days,no severe complication was found;average follow up was 15 months（3-36 months） ,loss rate of follow-up was 5 % ; 1-year survival rate was 91%,3 year survival rate was 76% ;the defecation frequence of the 6 patients subjected to pull through anastomosis was more, but became better later 6-9 months. Results show that as long as laparoscopie radical procedure is improved in technology,just could be used more extensively.
出处
《中国肛肠病杂志》
2011年第5期33-35,共3页
Chinese Journal of Coloproctology
关键词
直肠癌
腹腔镜检查
手术
Rectal carcinoma
Laparoscopy
Operation
